
<div class="form">
	<p></p>
	<form id="ndk-health-form" method="post" action="<?php echo Yii::app()->createUrl('finance/ExportReportBank'); ?>" target="_blank">
		<div class="row">
			<div class="col-md-4">
				<div class="widget box">

					<div class="widget-header">
						<h4><i class="icon-reorder"></i> Report POlis </h4>
					</div>


					<div class="widget-content">
						<strong><h4>Periode</h4></strong>

						<div class="control-group">
						<label class="control-label">Bulan</label>
						<div class="controls">
						<select id="bulan_bank" name="bulan_bank" class="form-control">
						<option value="01">Januari</option>
						<option value="02">Februari</option>
						<option value="03">Maret</option>
						<option value="04">April</option>
						<option value="05">Mei</option>
						<option value="06">Juni</option>
						<option value="07">Juli</option>
						<option value="08">Agustus</option>
						<option value="09">September</option>
						<option value="10">Oktober</option>
						<option value="11">November</option>
						<option value="12">Desember</option>
						</select>
						</div>
						</div>


						<div class="control-group">
						<label class="control-label">Tahun</label>
						<div class="controls">
						<input id="tahun_bank" class="form-control" type="text" name="tahun_bank" size="100">
						</div>
						</div>

					</div>

				</div>
			</div>
		</div>

		<div class="row">
			<div class="col-md-4">
				<div class="form-actions">
				<button class="btn btn-primary btn-large" id="btn_prev" type="button">Preview</button>
					<button class="btn btn-primary btn-large" name="yt0" type="submit">Cetak</button>
				</div>
			</div>
		</div>
	</form>

</div>



<div class="form">
<table class="table table-hover table-striped table-bordered table-highlight-head" id="tbl_polis">
	<thead>
		<tr>
			<th style="text-align:center">Client No.</th>
			<th style="text-align:center">Client Name</th>
			<th style="text-align:center">Type Of Insurance</th>
			<th style="text-align:center">Sum Insured</th>
			<th style="text-align:center">Gross Premium</th>
			<th style="text-align:center">Nett Brokerage</th>
			<th style="text-align:center">Nett Premium</th>
		</tr>
	</thead>
	<tbody>
	
	</tbody>
	
</div>